John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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HIV-associated obstructive portopathy, an emerging liver disease in HIV-infected patients Volume 16, issue 1, Janvier-Février 2009

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Inserm U567, unité d’hépatologie, APHP, université Paris-Descartes, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France

The decline in the mortality specifically related to the human immunodeficiency virus (HIV) has triggered an increase of the liver-related morbidity and mortality; liver diseases represent at the HAART era one of the three non-AIDS leading causes of death among HIV-infected patients with cardiovascular diseases and cancer. Liver diseases in HIV-infected patients are usually secondary to the toxicity of treatments, to the metabolic syndrome, to excessive alcohol consumption and to co-infection by one or several hepatotropic viruses. Recently, several cases of unexplained liver disease in patients with a long history of HIV infection and adequate immune restoration with antiretrovirals have been reported. Vascular liver diseases presenting either as nodular regenerative hyperplasia, hepatoportal sclerosis and sinusoidal dilatation seem to account for some of these cases. Small portal vein obliteration secondary to an acquired prothrombotic state due to a persistent immune dysregulation despite immune restoration could be part of the mechanism. Antiviral drugs could also contribute to the genesis of this type of injury. We detail in this review these vascular liver disorders that we have proposed to denominate HIVOP for HIV-associated obstructive portopathy.